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目的观察射频消融左上肺静脉脂肪垫(left superior pulmonary vein fat pad,LSPV-FP)对心房颤动(AF)的影响。方法 12只健康杂种犬,麻醉插管后持续心电监测;于双侧颈部暴露迷走神经干,左右侧第4肋间开胸并暴露LSPV-FP;分别测量基础、刺激迷走神经、消融LSPV-FP、刺激迷走神经+消融LSPV-FP 4种状态下的心房及左上肺静脉有效不应期(ERP)和有效不应期离散度(dERP)、AF诱发率、AF时心室率。结果基础状态下,刺激左侧或右侧迷走神经干可明显缩短心房ERP[(84.44±29.50)ms vs(129.7±15.83)ms,(85.42±26.11)ms vs(129.7±15.83)ms,P<0.05]、增大dERP[(71.67±14.03)ms vs(34.17±18.32)ms,(57.5±24.17)ms vs(34.17±18.32)ms,P<0.05]、增大左上肺静脉近端与远端ERP的差异(P<0.05)、增加AF的诱发率[(5.33±1.231)次vs(0.75±0.96)次,(4.67±1.155)次vs(0.75±0.96)次,P<0.05]及降低AF时心室率[(143.6±22.42)次/min vs(226.3±28.50)次/min,(146.4±30.72)次/min vs(226.3±28.50)次/min,P<0.05]。消融LSPV-FP可以逆转刺激左侧迷走神经干所致的上述变化(P<0.05),但对右侧迷走神经刺激干所致的电生理变化无显著影响。结论左侧迷走神经干纤维部分通过LSPV-FP对心房颤动的触发或维持发挥作用。
Objective To observe the effect of left upper pulmonary vein fat pad (LSPV-FP) on atrial fibrillation (AF). Methods 12 healthy mongrel dogs were enrolled in the study. Cardiac monitoring was performed after anesthesia intubation. The vagus nerve trunk was exposed on both sides of the neck and left thoracotomy on the fourth intercostal space. LSPV-FP was exposed. LSPV-FP was measured and the vagus nerve was stimulated. , The atrial and superior left pulmonary veins effective refractory period (ERP) and effective refractory period dyssynchrony (dERP), the rate of AF induction, the ventricular rate at AF in vagal + ablation LSPV-FP. Results In the basal state, stimulation of left or right vagus nerve trunk could significantly reduce atrial ERP [(84.44 ± 29.50) ms vs (129.7 ± 15.83) ms, (85.42 ± 26.11) ms vs (129.7 ± 15.83) ms, P <0.05 ] Increased the dERP [(71.67 ± 14.03) ms vs (34.17 ± 18.32) ms, (57.5 ± 24.17) ms vs (34.17 ± 18.32) ms, P <0.05] (P <0.05), increased the induction rate of AF [(5.33 ± 1.231) vs (0.75 ± 0.96) times, (4.67 ± 1.155) vs (0.75 ± 0.96) times, P <0.05] Rate of 143.6 ± 22.42 times / min vs 226.3 ± 28.50 times / min, 146.4 ± 30.72 times / min vs 226.3 ± 28.50 times / min, P <0.05. The ablation of LSPV-FP reversed the above changes induced by left vagus nerve stimulation (P <0.05), but had no significant effect on electrophysiological changes induced by vagus nerve stimulation on the right side. Conclusion Part of the left vagal nerve fibers play a role in the triggering or maintenance of atrial fibrillation by LSPV-FP.